Volume 2, Issue 3 (Summer 2016 -- 2016)                   JCCNC 2016, 2(3): 185-198 | Back to browse issues page


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Najafi Ghezeljeh T, Kalhor L. Review Paper: The Bed Incline and Prevention of Ventilator-Associated Pneumonia. JCCNC 2016; 2 (3) :185-198
URL: http://jccnc.iums.ac.ir/article-1-97-en.html
1- Department of Intensive Care and Blood Circulation Technology, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Department of Intensive Care and Blood Circulation Technology, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran , leila.kalhor22@gmail.com
Abstract:   (6532 Views)

Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial (hospital acquired) infection among patients undergoing mechanical ventilation. It increases mortality rate, duration of mechanical intubated ventilation, and hospitalization in the Intensive Care Units (ICUs). This review study aims to determine the proper gradient of a hospital bed in preventing VAP in patients hospitalized in ICUs.

Methods: In this study, research articles published from 1999 to 2016 were searched in PubMed, Science Direct, SID, and library sources, using keywords of “ventilator-associated pneumonia” and “elevated bed incline” and their corresponding terms in the Persian language.

Results: Results of the review showed that limited studies have been conducted on comparing the different inclines of bed and their effects on preventing VAP. Also, the available studies had methodological limitations or hospital staff failed to keep the patient in the same bed incline which was under the study for prolonged duration. Based on 19 reviewed studies, the incidence of VAP, hospital costs, mortality rate, and duration of mechanical ventilation in patients whose beds were inclined at 45 degrees or 30-45 degrees were significantly lower compared to patients reclining in the supine position. Although, in most conducted studies there were no consensus over a suitable bed incline in prevention of VAP and bedsore.

Conclusion: Raising the incline of bed can play a role in lowering the incidence of VAP, mortality rate, hospital costs and duration of mechanical ventilation. However, the proper gradient is not definite and requires studies with proper methodology in this regard.

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Type of Study: Research | Subject: Special
Received: 2015/11/26 | Accepted: 2015/03/31 | Published: 2017/01/25

References
1. Akin Korhan, E., Hakverdioglu Yont, G., Parlar Kilic, S. & Uzelli, D. 2013. 'Knowledge levels of intensive care nurses on prevention of ventilator-associated pneumonia'. Nursing in Critical Care, 19(1), pp. 26–33. doi: 10.1111/nicc.12038. [DOI:10.1111/nicc.12038]
2. Alexiou, V. G., Ierodiakonou, V., Dimopoulos, G. & Falagas, M. E. 2009. 'Impact of patient position on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials'. Journal of Critical Care, 24(4), pp. 515–22. doi: 10.1016/j.jcrc.2008.09.003. [DOI:10.1016/j.jcrc.2008.09.003]
3. Bakhtiari, S., Yazdannik, A., Abbasi, S. & Bahrami, N. 2015. 'The effect of an upper respiratory care program on incidence of ventilator-associated pneumonia in mechanically ventilated patients hospitalized in intensive care units'. Iranian Journal of Nursing and Midwifery Research, 20(3), pp. 354-358. PMCID: PMC4462061 [PMID] [PMCID]
4. Ballew, C, Buffmire, M. V., Fisher, C., Schmidt, P., Quatrara, B., Conaway, M., & Burns, S. M. 2011. 'Factors associated with the level of backrest elevation in a thoracic cardiovascular intensive care unit'. American Journal of Critical Care, 20(5), pp. 395–399. doi: 10.4037/ajcc2011884. [DOI:10.4037/ajcc2011884]
5. Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., et al. 2009. 'Enteral nutrition practice recommendations'. Journal of Parenteral and Enteral Nutrition, 33(2), pp. 122-67. doi: 10.1177/0148607108330314 [DOI:10.1177/0148607108330314]
6. Chen G., Wang J., Liu C., Xu R., Li Q., Zhou X., et al. 2016. A.S.P.E.N. 'Enteral nutrition practice recommendations'. Journal of Parenteral and Enteral Nutrition, 33(2), pp. 122–167. doi: /10.1177/0148607108330314
7. Drakulovic, M. B., Torres, A., Bauer, T. T., Nicolas, J. M., Nogue, S. & Ferrer, M. 1999. 'Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial'. Lancet, 354(9193), pp. 1851–1858. doi: 10.1016/s0140-6736(98)12251-1 [DOI:10.1016/S0140-6736(98)12251-1]
8. Elorza Mateos, J., Ania Gonzalez, N., Agreda Sadaba, M., Del Barrio Linares, M., Margall Coscojuela, M. A. & Asiain Erro, M. C. 2011. 'Nursing care in the prevention of ventilator-associated pneumonia'. 2011. Enfermería Intensiva, 22(1), pp. 22–30. doi: 10.1016/j.enfi.2010.11.006 [DOI:10.1016/j.enfi.2010.11.006]
9. Ferreira, C. R., De Souza, D. F., Cunha, T. M., Tavares, M., Reis, S. S. A., Pedroso, R. S. & Röder, D. V. D. D. B. 2016. 'The effectiveness of a bundle in the prevention of ventilator-associated pneumonia'. The Brazilian Journal of Infectious Diseases, 20(3), pp. 267–271. doi: 10.1016/j.bjid.2016.03.004 [DOI:10.1016/j.bjid.2016.03.004]
10. Grap MJ, Munro CL, Bryant S, Ashtiani B. 2003. 'Predictors of backrest elevation in critical care'. Intensive Critical Care Nursing, 19(2), pp. 68-74. PMID: 12706732 [DOI:10.1016/S0964-3397(03)00028-4]
11. Grap MJ, Munro CL, Hummel RS, Elswick RK, McKinney JL, & Sessler CN. 2005. 'Effect of backrest elevation on the development of ventilator-associated pneumonia'. American Journal of Critical Care, 14(4), pp. 325-32. PMID: 15980424 [PMID]
12. Hamishehkar, H., Vahidinezhad, M., Mashayekhi, S. O., Asgharian, P., Hassankhani, H. & Mahmoodpoor, A. 2014. 'Education alone is not enough in ventilator associated pneumonia care bundle compliance'. Journal of Research in Pharmacy Practice, 3(2), pp. 51-55. doi: 10.4103/2279-042X.137070 [DOI:10.4103/2279-042X.137070]
13. Hanneman, S. K. & Gusick, G. M. 2005. 'Frequency of oral care and positioning of patients in critical care: A replication study'. American Journal of Critical Care, 14(5), pp. 378-86. PMID: 16120889 [PMID]
14. Hyun, S., Li, X., Vermillion, B., Newton, C., Fall, M., Kaewprag, P., Moffatt-Bruce, S. et al. 2014. 'Body mass index and pressure ulcers: Improved predictability of pressure ulcers in intensive care patients'. American Journal of Critical Care, 23(6), pp. 494–501. doi: 10.4037/ajcc2014535. [DOI:10.4037/ajcc2014535]
15. Jackson, M., Mckenney, T., Drumm, J., Merrick, B., Lemaster, T. & Vangilder, C. 2011. 'Pressure ulcer prevention in high-risk postoperative cardiovascular patients'. Critical Care Nurse, 31(4), pp. 44–53. doi: 10.4037/ccn2011830 [DOI:10.4037/ccn2011830]
16. Keeley, L. 'Reducing the risk of ventilator-acquired pneumonia through head of bed elevation'. Nursing in Critical Care, 12(6), pp. 287–294. doi: 10.1111/j.1478-5153.2007.00247.x [DOI:10.1111/j.1478-5153.2007.00247.x]
17. Klompas, M., Branson, R., Eichenwald, E. C., Greene, L. R., Howell, M. D., Lee, G., et al. 2014. 'Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update'. Infection Control & Hospital Epidemiology, 35(2), pp. 133–154. doi: 10.1017/s0899823x00193894 [DOI:10.1017/S0899823X00193894]
18. Kollef, M. H., Prentice, D., Shapiro, S. D., Fraser, V. J., Silver, P., Trovillion, E., et al. 1997. 'Mechanical ventilation with or without daily changes of in-line suction catheters'. American Journal of Respiratory and Critical Care Medicine, 156(2), pp. 466–472. doi: 10.1164/ajrccm.156.2.9612083 [DOI:10.1164/ajrccm.156.2.9612083]
19. Leng, Y. X., Song, Y. H., Yao, Z. Y. & Zhu, X. 2012. 'Effect of 45 degree angle semirecumbent position on ventilator-associated pneumonia in mechanical ventilated patients: A meta-analysis'. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, 24(10), pp. 587-91. PMID: 23040773 [PMID]
20. Lippoldt, J., Pernicka, E. & Staudinger, T., 2014. Interface pressure at different degrees of backrest elevation with various types of pressure-redistribution surfaces. American Journal of Critical Care, 23(2), pp. 119–126. doi: 10.4037/ajcc2014670 [DOI:10.4037/ajcc2014670]
21. Metheny, N. A., Clouse, R. E., Chang, Y. H., Stewart, B. J., Oliver, D. A. & Kollef, M. H. 2006. 'Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors'. Critical Care Medicine, 34(4), pp. 1007–1015. doi: 10.1097/01.ccm.0000206106.65220.59 [DOI:10.1097/01.CCM.0000206106.65220.59]
22. Metheny, N. A., Davis Jackson, J. & Stewart, B. J., 2010. Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), pp. 18–25. doi: 10.1097/nnr.0b013e3181c3ba05 [DOI:10.1097/NNR.0b013e3181c3ba05]
23. Najafi Ghezeljeh, T., Kalhor, L., & Haghani, H. 2016. 'Comparing the effect head of bed elevation 30 and 45 degree on incidence of Ventilator Associated Pneumonia in patients admitted tointensive care units'. MSc thesis, Iran University of Medical Sciences,Tehran.
24. Narang, S. 2008. 'Use of ventilator bundle to prevent ventilator associated pneumonia'. Oman Medical Journal, 23(2), pp. 96-99. PMCID: PMC3282421 [PMID] [PMCID]
25. Niel-Weise, B. S., Gastmeier, P., Kola, A., Vonberg, R. P., Wille, J. C. & Van Den Broek, P. J. 2011. 'An evidence-based recommendation on bed head elevation for mechanically ventilated patients'. Critical Care, 15(2), pfp. 111. doi: 10.1186/cc10135 [DOI:10.1186/cc10135]
26. Palmer, L. B., Albulak, K., Fields, S., Filkin, A. M., Simon, S. & Smaldone, G. C. 2001. 'Oral clearance and pathogenic oropharyngeal colonization in the elderly'. American Journal of Respiratory and Critical Care Medicine, 164(3), pp. 464–468. doi: 10.1164/ajrccm.164.3.2008149 [DOI:10.1164/ajrccm.164.3.2008149]
27. Pugin, J., Auckenthaler, R., Mili, N., Janssens, J. P., Lew, P. D. & Suter, P. M. 1991. 'Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid'. American Review of Respiratory Disease, 143(5), pp. 1121–1129. doi: 10.1164/ajrccm/143.5_pt_1.1121 [DOI:10.1164/ajrccm/143.5_Pt_1.1121]
28. Rose, L., Baldwin, I., Crawford, T. & Parke, R. 2010. 'Semirecumbent positioning in ventilator-dependent patients: a multicenter, observational study'. American Journal of Critical Care, 19(6), pp. 100–108. doi: 10.4037/ajcc2010783 [DOI:10.4037/ajcc2010783]
29. Schallom, M., Dykeman, B., Metheny, N., Kirby, J. & Pierce, J. 2014. 'Head-of-bed elevation and early outcomes of gastric reflux, aspiration and pressure ulcers: A feasibility study'. American Journal of Critical Care, 24(1), pp. 57–66. doi: 10.4037/ajcc2015781 [DOI:10.4037/ajcc2015781]
30. Serpa, L. F., Santos, V. L., Peres, G. R., Cavicchioli, M. G. & Hermida, M. M. 2011. 'Validity of the Braden and Waterlow subscales in predicting pressure ulcer risk in hospitalized patients'. Applied Nursing Research, 24(4), pp. 23–28. doi: 10.1016/j.apnr.2010.05.002 [DOI:10.1016/j.apnr.2010.05.002]
31. Taraghi Z., Darvishi Khezri H., Gholipour Baradari A., Heidari Gorji M. A., Sharifpour A., & Ahanjan, M. 2011. Evaluation of the antibacterial effect of persica mouthwash in mechanically ventilated Icu patients: A double blind randomized clinical trial. Middle-East Journal of Scientific Research. 10(5), pp. 631-637.
32. Van Nieuwenhoven, C. A., Vandenbroucke-Grauls, C., Van Tiel, F. H., Joore, H. C., Van Schijndel, R. J., Van Der Tweel, I., et al. 2006. 'Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: A randomized study'. Critical Care Medicine, 34(2), pp. 396–402. Available at: doi: 10.1097/01.ccm.0000198529.76602.5e [DOI:10.1097/01.CCM.0000198529.76602.5E]

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